Regional Committee: Highlights of Day 3

Today the Regional Committee agreed on a regional framework for the surveillance and control of vector-borne diseases such as dengue and chikungunya fever, and welcomed the signing of a Joint Framework Agreement between WHO, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA).

Regional framework for the surveillance and control of invasive mosquito vectors and re-emerging vector-borne diseases

The WHO European Region has seen increasing activity from vector-borne diseases in recent years, notably an outbreak of chikungunya fever in 2007, and of dengue in 2010. Dr Guenael Rodier of WHO/Europe explained that a combination of factors, including the globalization of trade and travel, urbanization and climate change, has created favourable conditions for the introduction and spread of mosquito-borne diseases in the Region. The proposed regional framework will assist Member States in national-level activities to detect and respond quickly to the spread of invasive species of Aedes mosquito, and related diseases – dengue and chikungunya fever.

The framework was welcomed by countries, and Lithuania, speaking on behalf of the European Union Member States commented: “We should not underestimate the health risk posed by invasive mosquitoes. Countries must be prepared to respond.” The delegation of the Netherlands expressed its willingness to support WHO/Europe in this area, and the delegation from the Russian Federation offered specific support in training health professionals.

WHO/Europe’s collaboration with the European Centre for Disease Prevention and Control as well as the European Mosquito Control Association was praised, and the creation of a platform to facilitate and coordinate activities such as analysis of surveillance data, cross-border interventions, and exchange of information and experiences, was warmly received.

Member States adopted the resolution on the regional framework, with an amendment to include West Nile fever by the Russian Federation included.

Progress report on measles and rubella elimination

Despite great strides in efforts to eliminate measles and rubella from the European Region, several countries are still experiencing outbreaks, and cases are appearing more frequently among adolescents and young adults, rather than in children. Dr Guenael Rodier, WHO/Europe, explained that despite public complacency, measles and rubella are not benign diseases. In order to achieve elimination by the target date of 2015, accelerated action in several areas is needed. These include: strengthening vaccination and immunization systems; surveillance; verification of measles and rubella elimination; and communication, information and advocacy.

The WHO Region of the Americas has already eliminated measles and rubella. The former WHO Regional Director for the Americas, Dr Mirta Roses explained in plenary the innovative steps taken to eradicate the disease, from galvanizing Hillary Clinton as a strong advocate, to setting up immunization stations outside sports stadiums. She expressed her concern about the threat of imported cases from Europe to other parts of the world, and concluded: “Measles and rubella elimination is possible and worth it. Do it.”

In their interventions, Member States expressed their continued commitment to eliminate measles and rubella. Despite many challenges cited by countries – specifically, addressing public safety concerns and resistance from ideological groups; the influence of anti-vaccination groups; filling past gaps in immunization coverage; and reaching those who lack access to health services – action is being stepped up. These activities include widespread vaccination campaigns followed by targeted initiatives in specific areas and among the underserved, free vaccination, strengthening surveillance, and providing the public with information on vaccine safety.

Governance reform of WHO/Europe

Dr Ray Busutill, Chair of the working group on governance set up by the Standing Committee of the Regional Committee (SCRC), described seven issues the group had reviewed at several meetings during the year, reflecting the fine balance between transparency and accountability on the one hand and efficiency on the other. All resulting procedural changes would be reflected as appropriate in the rules of procedure of the Regional Committee and the SCRC.

The process for nominations to the SCRC and the Executive Board remained fundamentally unchanged, but would benefit from wider publicity about upcoming vacancies; and precedence would be given to semi-permanent members when drawing up lists of nominees.

The transparency of SCRC proceedings had increased with the opening up of the May meetings to all Member States, with greater access to much of the documentation, and with the videostreaming of the opening sessions of each meeting. In future, the plan was to publish the contact details of SCRC members on a password-protected web site for Member States.
Precise deadlines were set for both submission and amendment of Regional Committee resolutions.

The new mechanism for screening the credentials of Member States attending Regional Committee sessions had been activated, but countries were urged to submit them in good time.

Communication between SCRC members and Member States would be improved by the nomination of SCRC focal points for each agenda item, and formal links made between the SCRC and subregional groupings.

WHO/Europe’s code of conduct for nomination of the Regional Director was reviewed, as part of the call for global governance reform, and brought into line with that of the WHO Regional Office for the Western Pacific.

In order to introduce a system for the staggered replacement of members of the European Environment and Health Ministerial Board, two members (chosen at random) were exceptionally requested to serve an extra year, beyond the usual two.

The delegates welcomed the increased transparency and opportunity to be more involved in the discussions of the SCRC, but remained concerned about the number of documents and agenda items presented to the Regional Committee, and the delay in finalizing them. Zsuzsanna Jakab, WHO Regional Director for Europe, also welcomed the increased transparency of the work of the SCRC and pointed out the shift in this year’s Regional Committee agenda from new items to reporting back on existing items, thus increasing WHO/Europe’s accountability to its Member States.

Review of resolutions

Dr Nedret Emiroglu of WHO/Europe presented a review of the status of all Regional Committee resolutions from the last 10 years currently in force, with a view to drawing up a reporting schedule, using existing reporting and end dates where they have them or creating such dates where they don’t. Where open-ended resolutions had been superseded by later resolutions, they were given immediate end dates.

The 46 resolutions collated were presented according to the six categories of work of the Twelfth General Programme of Work with an additional cross-cutting category, with proposals for reporting and end dates. These took into account the proposals made under the previous such review in 2008 and a recent web consultation. The delegates adopted the resolution endorsing the review (with one amendment) and the procedure for streamlining the reporting process, including the practice of specifying an end date for reporting on all future resolutions. This reporting process would be greatly facilitated in the future by the establishment of a searchable database of resolutions linked to related background documentation, including resolutions that they supersede. One delegate highlighted the fact that such a collation of resolutions represented in a stark way the entirety of WHO/Europe’s workplan and its related financial and human resources burden.

Technical briefing on implementing Health 2020: strengthening multisectoral responsibility for health in Turkey

A lunchtime technical briefing provided an opportunity for delegates from Turkey to describe how the Ministry of Health had developed a programme for improving multisectoral health responsibility. The aim of the programme is to mobilize parties to take up their responsibilities to promote health and strengthen public health functions in the spirit of cooperation. Participants noted that a multisectoral approach requires a change in mindset: to recognize and promote the co-benefits to health and other sectors; as a vital part of social justice and ensuring the participation of people; and to broaden the scope of the health sector to encompass well-being and not just medical issues.

Joint Framework Agreement with UNICEF and UNFPA

The regional offices of UNFPA, UNICEF and WHO today signed an agreement to strengthen their partnership.

The joint aim is to more effectively support Member States in achieving the health-related United Nations Millennium Development Goals (MDG 4, MDG 5 and MDG 6), and address new challenges in the Region in the context of Health 2020.

The agreement was signed by Marie-Pierre Poirier, UNICEF’s Regional Director for Central and Eastern Europe and the Commonwealth of Independent States, Werner Haug, UNFPA’s Regional Director for Eastern Europe and Central Asia, and Zsuzsanna Jakab, WHO Regional Director for Europe.

Establishment of WHO geographically dispersed office (GDO) on primary health care in Kazakhstan

The Declaration of Alma-Ata in 1978 laid out the vision, values and expectations for health systems to prioritize people-centred primary health care (PHC), re-emphasized by the vision of Health 2020.

The Government of Kazakhstan has offered to host and finance the running costs of an office on PHC, as part of WHO/Europe. The main objectives of this new office in Almaty would be to:

• develop conceptual and analytical frameworks for PHC-based service delivery, systematizing knowledge and evidence, and develop training packages;
• provide technical assistance to countries to implement PHC transformation;
• draft policy papers on good practices to inform policy recommendations; and
• ensure the alignment between health systems and global health initiatives, as well as building partnerships with relevant stakeholders.

The responsibility for formulating policy, setting norms and standards, and developing guidelines would remain with WHO/Europe’s head office in Copenhagen.

Noting the significance of Kazakhstan’s long-standing commitment to PHC, and the location of the office in Almaty where the Declaration of Alma-Ata was signed, Member States approved the establishment of the new GDO on PHC in Kazakhstan. 

Establishment of WHO GDO on preparedness for humanitarian and health emergencies in Turkey

Health security demands – emergency preparedness and rapid risk management - are increasing across the European Region. The new global WHO Emergency Response Framework also places increasing demands on WHO country and regional offices. The activities of the proposed GDO would include:

• assessment of national health system capacity for crisis management;
• capacity-building and training in an all-hazards approach;
• assessment of hospital vulnerability and strategies to improve disaster resilience;
• support to countries hosting mass gatherings;
• technical assistance in contingency planning for humanitarian and health emergencies;
• devising and running multicountry exercises; and
• on request, supporting the WHO response to emergencies.

Member States approved the establishment of the new GDO on preparedness for humanitarian and health emergencies in Istanbul, Turkey. 

Progress reports on other GDOs

The Russian Federation announced that progress was being made on opening a GDO on noncommunicable diseases in Moscow. The budget had been confirmed, and the office was expected to open in 2014.

The work and financing of other GDOs, on health financing in Barcelona, Spain, environment and health in Bonn, Germany, and investment for health and development in Venice, Italy were described. Presenters underlined the important achievements made by these offices, including scientific and technical assistance to countries, scientific publications, and capacity building and training. As funding is primarily through host agreements with countries, it was noted that GDOs contribute much more than they cost to Member States.

Meeting with nongovernmental organizations (NGOs)

Before the day’s proceedings in plenary began, Zsuzsanna Jakab, WHO Regional Director, held a short informal meeting with NGOs and other civil society representatives to discuss how to enable them to give visible input in plenary at Regional Committee sessions, in addition to their written and video statements already available online. Recognizing that regional committees are Member-State-driven, those attending noted that improvements had been made in recent years to harness the knowledge and expertise of NGOs and take account of their concerns on health issues, and today’s meeting was warmly welcomed. Participants asked WHO to set an example to other organizations and governments on collaboration with civil society, but also noted that NGOs themselves should coordinate messages prior to sessions and arrange coordination meetings. Ms Jakab acknowledged the great contribution made by NGOs to health in the European Region, and made a specific suggestion to improve exchange through secondments by civil society organizations to WHO/Europe.

During the Regional Committee session, the Regional Director has also held a series of bilateral meetings with Member States. These have included discussions with the delegation of Turkmenistan on the upcoming ministerial conference on noncommunicable diseases in December this year, and an expression of support to the delegation from Israel for the Government’s ongoing commitment and action to stop the environmental circulation of wild poliovirus type 1.

Highlights for Thursday

• European Mental Health Action Plan 2014–2020
• Matters arising from the World Health Assembly and Executive Board
• Progress reports on multidrug-resistant tuberculosis, tobacco control, the food and nutrition action plan, the noncommunicable diseases strategy, the health-related Millennium Development Goals, the International Health Regulations and antibiotic resistance.